Psychiatry: Neurodevelopment Flashcards
what is ADHD ? characterised by what ? (3)
neurodevelopment disorder characterised by:
- inattention
- hyperactivity
- impulsiveness
how does ADHD often present to health care ?
due to poor school performance or sorptive behaviour
describe ADHD symptoms ? characters by the 3 domains
- inattention: difficult maintaining focus on thought/ task, easily distracted, task avoidance, signore instruction, lose things, disorganised, forgetfull
- Hyperactivity: energetic, difficulty sitting still/ withholding impulsions
- Impulsiveness: talk excessively, blurt out answers, can’t wait turn, interrupt
ADHD Dx ? requirements ? how long Sx for ? Sx onset ?
functionally imparting inattention, hyperacitivy and or impulsiveness (in 2 or more settings) for more than 6 monts
- young at onset (<12 yrs)
first line ADHD managment in children ? second line
(6-18)
- stimulant (methylphenidate), psychoeducation, +/- behavioural therapy
- 2nd line: different class of stimulant (amphetamine)
how do stimulants work ind ADHD Mx ?
increase dopamine and NAd => improve attention + hyperactivity
SE of ADHD Mx ?
methylphendate, amphetamine salts
- SE: growth restriction, appetite suppression, insomnia, addiction
What is ASD ? characterised by what ? (2)
neurodevelopemtnal disorder characterised by:
- difficulty in social communication/interaction
- Restricted interest/activites
ASD Dx ?
difficulty in social communication + restricted interest/activity present since early childhood => impairing function (exclude other causes)
what are some of the social communication Sx associated with ASD ? difficulty with what ?
- used of language (verbal + non-verbal) difficulties): delayed speech dev (or mute), struggle understanding + using body language/facial expression), only literal
- difficulty with: reprocity, turn-taking and sharing
describe the restricted/repetitiv pattern associated with ASD ?
insistence upon sameness
- same food/activies
- special interest
what other symptoms might there be in ASD ?
- sensory disturabce
- Savantism
- reduced cognition (I think)
ASD epi ?
0.1-2%
- M>F (x4)
ASD Mx ?
- behavioural therapy
- speech and language therapy
what is a somatisation or somatiform disorder ?
body based/somatic sx (pain, nausea, SOB)
- resemble physical disorder but actually psychological (no pathology)
what is somatic disorder ? Dx ?
- somatic Sx
- medically unexplained
- accompanied by maladaptive thoughts + feelings: anxiety, time + energy
name some of the common presentation is somatic disorder ? most common ?
pain, fatigue, dizziness, stiffness, palpitations, N+V
- pain is actually experiences (not fake)
- GI tract most common presentation (diarrhoea, vomiting, constipation)
(chronic and impairing)
Somatic Symptom disorder Mx ? (3)
- CBT
- Mindfullness based therpy
- Antidepressants
somatisation RF ? (3)
- female
- sexual or physical assualt
- ACEs
What is illness anxiety disorder ? associated with what ? describe this
obsessional preoccupation that one has a medical disease
- under ocd spectrum: obsessive thought (belief that ill) => impulsive behaviour (check sings + Sx) => distress + dystfuciton => repeat
how illness anxiety disorder different to somatic Sx disorder ?
somatic Sx disorder is focus on Sx where illness anxiety is stress is not about the Sx but the disease (will make condition worse when no Dx found)
What is conversion disorder ? aka ? link with what ?
functional neurologic disorder
- clinically unexplained abnormality of nervous system brought on by stressful trigger (Sx not faked)
- link with dissociative disorders
conversion disorder Px ?
similar to somatic Sx disorder however is specifically neuro
- weakness, blindness, numbness, loss of function
conversion disorder Mx ?
education on disorder (but do not imply that they are lying)
name some conditions that present with fake presenting complaints ?
- factitious disorder
- malingering
what is factitious disorder ?
(munchhausens)
- fabricated to gain social benefits associated with the sick role (sympathy)
what is malingering ?
fabricated presentation to gain some external reward (liability benefits, stay in hospital)
What is Body dysmorphia ? associated with what condition ?
Mental fixation that specific aspects of ones appearance are flawed/deformed
- OCD spectrum disorder
describe some of the features of body dimorphic thinking ?
entirely based on perception + not on what objective outsider would think
- Ego-syntoinic, disabiling
how is body dysmorphia like OCD ?
obsessions: intrusive, mid based, unwanted, resistant, distressing, recurrent
- compulsions: measuring, weighing, body checking
- leading to distress + dysfunction
Body dysmorphia Mx ?
same as OCD: CBT, consider SSRI
what are eating disorders ? generally, causing ?
pattern of abnormal food intake that decreases someones ability to maintain adequate nutrition => physical + psychological health disorders
what do anorexia and bulimia have in common ?
overvalue beliefs about weight + maladaptive behaviours
what is anorexia nervosa ? characterised by ?
perceive to be overweight despite being underweight (often use BM < 17.5)
- nervous about gaining weight (constant preoccupation)
- distorted perception (body dysmorphia)
- excessive exercise (+use of laxatives)
- restricting calories
(similar to OCD thinking again)
what are some of the physical manifestations of anorexia ? (9)
- fatigue
- amenorrhoea
- osteoporosis
- cardiac arhythmias (hypokalaemia)
- lanugo hair
- hypotension
- reduced temp
- mood changes
- cold
anorexia Epi ? M:F ? mortality ?
<0.5%
F>M (x20)
20% mortality
wha Is bulimia nervosa ? characterised by what ?
- binge eating: eating v large amounts with no control, emotional numbness during eating, disgust post-eating
- offsetting/purging (self induced vomiting)
- linked to self esteem
what personality disorder is bulimia linked to ? anorexia ?
anorexia: OCPD
bulimia: BPD
what are some of the effects of self induced vomiting (signs+sympotms) ?
- erosion of dental enamel
- swollen salivary glands
- injury on back of knuckles (Russell sign)
- Kidney disease from dehydration
- gastric ulcers
what blood gas associated with bulimia ?
metabolic alkalosis
bulimia Mx ? don’t use what ?
CBT + SSRIs
- do not use bupropion ! (increases risk of siezures)
What is binge eating disorder ? often triggered by what ? associated with what ?
similar to bulimia but not offset by purging => often overweight
- associated with BPD
- often overeat due to underlying psychological distress
what is ARFID ?
avoidant/restrictive food intake disorder (ARFID): tend to avoid food/ narrow selection => failure of adequate nutrition (not related to body image)
what is referring syndrome ? who at risk more ? (2)
occurs in Px who have been in severe nutritional defect for an extended period and then resume feeding
- Px at higher risk: BMI < 20, little toe at for past 5 days
(risk increases with lower BMI and more days without eating)
describe the pathophys of refeeding syndrome ?
cell metabolism slows during prolonged malnutrition => feed => starved cells process glucose + protein + fats => electrolyte abnormalities
what electrolyse abnormalities are there in referring ? (3) risk of what ? (3)
- hypomagnesia
- hypokalaemia
- hypophosphataemia
risk of: cardiac arrhythmias, fluid imbalances, heart failure
refeeding syndrome Mx ?
- slowly reindorodece food + restrict calories
- MG, K, Pohs + glucose monitoring
- fluid balance monitoring
- ECG monitoring
- Supplementation (B vits, Thiamine)
What is adjustment disorder ?
depressive and/or anxious sx that occur after major life stressors (divorce, lose job)
- often subsyndromal depression (<5/9)
adjustment disorder Mx ?
supportive therapy
what is catatonia ?
abnormal mental state characterised by changes in consciousness + behaviour
catatonia presentaiton ?
- lethargy (sedated despite eyes open)
- immobility (lack of movement => malnutrition + dehydration)
- mutism (absent verbal communication)
- positioning (holding abnormal positions)
- echolalia, echopraxia
what conditions is catatonia associated with ?
- BP
- MDD
- schizophrenia
catatonia Mx ? (3) gold standard
- benzos
- ECT (gold standard but start with benzos as less invasive)
- discontinue AP
